VIRAL HEPATITIS IN BRAZIL – INVISIBLE PATTERNS AND SILENCES OF EPIDEMIOLOGICAL SURVEILLANCE: RECENT TRENDS, GEODEMOGRAPHIC ASYMMETRIES, AND UNDERREPORTING IN TIMES OF HEALTH CRISIS

Abstract

Viral hepatitis constitutes a serious public health problem in Brazil, marked by heterogeneous epidemiological patterns that are often invisible to official surveillance. Although data from the Unified Health System (SINAN and SIM) reveal more than 800,000 confirmed cases between 2000 and 2024, the distribution among viruses A, B, C, D, and E shows significant regional and demographic asymmetries. The Northeast concentrates the highest proportion of hepatitis A, the Southeast leads in B and C, and the North accounts for more than 70% of hepatitis D cases, forming a picture of territorial contrasts that highlights inequalities in access to prevention, diagnosis, and treatment. In recent years, emerging phenomena have drawn attention: the shift of hepatitis A to older age groups, with increased deaths among the elderly; a sudden 54.5% rise in its incidence in 2024; widespread underreporting during the COVID-19 pandemic; and high rates of incomplete records, such as the absence of the probable transmission route in about 60% of hepatitis C cases. Despite its epidemiological relevance, there remain gaps in the integrated analysis of the five types of viral hepatitis in Brazil, especially regarding the impact of socioeconomic conditions, the role of sanitation in hepatitis A, the underreporting of rare forms (D and E), and the discontinuity of notifications during health crises. Thus, this study aims to analyze hepatitis A, B, C, D, and E jointly in Brazil, using secondary SUS databases to examine recent temporal trends, geodemographic inequalities, and weaknesses in epidemiological surveillance. The guiding question is: how have invisible patterns, data gaps, and the effects of the COVID-19 pandemic impacted the current understanding of the epidemiology of viral hepatitis in Brazil? Theoretically, the study draws on works by Focaccia (2015; 2021), Veronesi (2015), Ferreira and Silveira (2004), WHO (2016; 2024), Ministry of Health (2005; 2008; 2016; 2017; 2018; 2024; 2025), Rêgo et al. (2018), Berkman and Kawachi (2000), Lee et al. (2010), McLachlan (1991), Sofia (2019a; 2019b), Marmot (2013), Colvin and Mitchell (2010), Waldman (1998), Cromley and McLafferty (2011), Elliott et al. (2001), Handa and Yamaguchi (2006), Thomas et al. (2013), Zuckerman et al. (1999; 2009), Wang (2023), Ozaras et al. (2018; 2019a; 2019b), Bastos (2024), Veras et al. (1998), among others. The research is qualitative (Minayo, 2007), bibliographic and descriptive (Gil, 2008), with a comprehensive analytical bias (Weber, 1949). The findings reveal that the epidemiology of viral hepatitis in Brazil remains marked by structural inequalities, institutional invisibility, and historical discontinuities in epidemiological surveillance. It was found that data fragmentation and underreporting, intensified during the COVID-19 pandemic, distort the true magnitude of the disease, especially in the North and Northeast regions. Furthermore, the study identified that the territorial distribution of the viruses reflects social determinants such as poverty, poor sanitation, and unequal access to health services. Thus, it was observed that strengthening SUS, together with intersectoral and territorialized surveillance, is essential to overcome epidemiological silences and ensure effective prevention and control responses.